It is interesting to think about how healthcare changed over the years. Working as a nurse practitioner or as a healthcare provider in general looks a lot different than it did 40, 20, even 10 years ago. There are many changes the healthcare system has experienced. And I am not just talking about the changes since going through a global pandemic).
Granted, I have been working in healthcare for about 13 years, so I did not experience how healthcare was years ago. Maybe these changes in healthcare are my own perceptions. Maybe it’s because the role of a nurse practitioner differs from when I was working as a RN. Maybe it is because of the stories I have heard from nurses/providers practicing 30 years ago and their own reflection of how healthcare has changed. Maybe my personal bias and life experiences have played a role.
But in this current world of constant change, here are a few ways healthcare changed over the years. (I would love to hear your comments and know if you think healthcare changed)!
How healthcare changed over the years
- I feel like our patients have gotten sicker. Fortunately, there are a lot more medical interventions we can provide for patients. But, sometimes this means a longer hospital stay and tougher management of more comorbidities in the outpatient setting. Patients are living longer which creates new challenges for healthcare providers. Not to mention there are new diseases such as COVID-19 and we are still learning long term effects.
- There is a push to see more patients. Providers used to have time available to sit with and educate their patients. Now patients are scheduled at 10-15 min appointments for a chronic disease follow-up (and sometimes double or even triple booked). This does not leave much time for nurse practitioners to educate on the disease process and nonpharmacological interventions. It seems like many healthcare facilities are more worried about the finances rather than the actual patient. This seems like a common way healthcare changed over the years.
- Admission criteria has become more strict about what patients get admitted to the hospital. There are so many criteria and qualifications the patient has to meet in order to stay at the hospital. I remember hearing how family members used to be able to have their loved ones admitted to the hospital while they were out of town for the weekend. Or patients would be allowed to stay in the hospital for several weeks at a time. Now healthcare staff start discharge planning about the same time the patient is admitted. No more long hospital stays is another way healthcare changed over the years.
- Increase in available treatments and increase in obstacles to prescribing. There are a lot more guidelines about what kind of tests or medication can be ordered. This has greatly impacted how healthcare has changed. Nurse practitioners now have to go through a lot more hoops to jump through such as prior authorizations. It makes it tough when you want to help the patient succeed and yet the insurance company denies the test or treatment. I understand medical necessity and not over spending on healthcare, but it’s a challenge. I personally hate doing prior authorizations, especially if they are denied. It is so frustrating to not be able to get the tests or treatments the patient needs, only because of the medical insurance guidelines. Anyone else find this frustrating?
- The responsibilities of healthcare providers have changed. I feel like nurse practitioners have taken on a lot of “other tasks.” There are constantly patient messages/phone calls, medication refills, reviewing of documentation, keeping up with best practice guidelines, etc. I also think about how providers used to be on call for their patients 24/7. Family practice providers rounded early in the morning and late at night on their hospital patients. There were no hospitalists to take some of the burden off. While I think having hospitalist services was a positive change, it seems like providers really haven’t freed up much of their time. Many are staying late at the office or bringing charts home, just trying to catch up. The increase responsibilities of healthcare along with less time to do the tasks is a negative way healthcare changed over the years.
- Challenges of electronic medical records (EMR). EMRs were developed to provide accessible and efficient continuation of patient care. If you are a nurse practitioner, you know the challenges associated with EMRs. I have talked with so many providers who note how much easier it was to complete paper charting. The notes were shorter, problem focused, and straight to the point. There were not all these extra buttons and redundant documentation. EMRs have been a huge reason healthcare has changed over the years.
- Loss of purpose or fulfillment. I remember thinking about the role of a nurse as I declared a pre-nursing route in high school. I thought nurses had so much time to sit and listen to their patients. I thought nurses were there to educate patients on healthy habits and non pharmacological ways to manage chronic disease. After starting my first RN job on a busy medical-surgical floor, I quickly realized this was not the case. I barely had enough time to eat or go to the bathroom, let alone have time to effectively educate patients. This was one of the reasons I became burned-out as a RN. I wish I had more time to improve patient’s lives, not just prescribe medication. Anyone else agree?
What do these changes mean for nurse practitioners?
Nurse practitioners truly care about our patients. We want to help them and give them the best treatment. The way healthcare changed over the past few years has brought new challenges. With the increase in role/responsibilities of a nurse practitioner and a decrease of support staff, it is no wonder nurse practitioners are struggling. These changes make our jobs challenging in different ways than previous healthcare providers. These obstacles make us at increased risk of nurse practitioner burnout.
If you are struggling with nurse practitioner burnout, know you are not alone. The Burned-out Nurse Practitioner offers helpful blog posts. You can join a group of equally burned-out nurse practitioners. While we cannot fix these how healthcare changed ourselves, we can come together as nurse practitioners and support one another.
For time management and charting tips, check out The Nurse Practitioner Charting School– The one stop for all documentation resources created specifically for nurse practitioners. Learn more at www.npchartingschool.com
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It is an unfortunate trend: when I became an NP in 1977, there was much physician resistance to the expanded role. Now we are in the struggle of our lives to do the best care for our many patients and strike a balance in our personal lives, with the threat of an oversight always looming in the form of malpractice. The rush to move people through clinics at an astounding rate plus the huge amount of documentation and followup required is tiring and stressful. It is my hope that our health care system awakens to provider burnout and hires scribes routinely to assist with documentation.
Great insight from your past experiences! It is sad how the healthcare system as a whole has shifted. I feel like its less about the patient and more about the $$$. Unfortunately, it would take a major movement to make these necessary changes!